Clinical Features of Typically Developing Children With and Without Prenatal Alcohol Exposure.

OBJECTIVE: To determine if prenatal alcohol exposure (PAE) affected physical and cognitive/behavioral outcomes in apparently typically developing, first-grade children. STUDY DESIGN: Three groups were compared: children with fetal alcohol spectrum disorders (FASD); children with PAE without FASD; and children without PAE. RESULTS: The three groups were significantly different on most physical traits and fewer neurodevelopmental traits. Two-group comparisons of exposed and unexposed, non-FASD groups were statistically different on: height, weight, head circumference (OFC), body mass index (BMI), and palpebral fissure length (PFL). Neurobehavioral outcomes were significant in three-group, but not two-group, comparisons. Few sex differences were observed; however, sex ratios indicated fewer male offspring in first grade among women who consumed 6+ drinks per occasion during pregnancy. For weight, OFC, BMI, age, rural residence, and drinking measures, mothers of exposed children without FASD were intermediaries between, and significantly different from, the other maternal groups. Adjusted for socioeconomic covariates, multivariate analysis of covariance (MANCOVA), three-group comparisons were significantly different for cognitive/behavioral variables (p<.001); however, two-group neurobehavior comparisons for children without FASD were not significant (p>.05). Physical trait MANCOVA comparisons of the non-FASD groups were significant only for weight (p<.004) when tested univariately and through stepdown analysis. Socioeconomic-adjusted trend plots were in the expected direction for nonverbal IQ, problem behaviors, attention, height, weight, OFC, vermilion, PFL, and total dysmorphology score. CONCLUSIONS: Even when meeting developmental norms, children with PAE exhibited trends of poorer growth and cognitive/behavioral traits than children without PAE. These findings support the notion that abstinence during pregnancy is best.

Exercise reduces physical alterations in a rat model of fetal alcohol spectrum disorders.

BACKGROUND: Prenatal alcohol exposure (PAE) has serious physical consequences for children such as behavioral disabilities, growth disorders, neuromuscular problems, impaired motor coordination, and decreased muscle tone. However, it is not known whether loss of muscle strength occurs, and which interventions will effectively mitigate physical PAE impairments. We aimed to investigate whether physical alteration persists during adolescence and whether exercise is an effective intervention. RESULTS: Using paradigms to evaluate different physical qualities, we described that early adolescent PAE animals have significant alterations in agility and strength, without alterations in balance and coordination compared to CTRL animals. We evaluated the effectiveness of 3 different exercise protocols for 4 weeks: Enrichment environment (EE), Endurance exercise (EEX), and Resistance exercise (REX). The enriched environment significantly improved the strength in the PAE group but not in the CTRL group whose strength parameters were maintained even during exercise. Resistance exercise showed the greatest benefits in gaining strength, and endurance exercise did not. CONCLUSION: PAE induced a significant decrease in strength compared to CTRL in PND21. Resistance exercise is the most effective to reverse the effects of PAE on muscular strength. Our data suggests that individualized, scheduled, and supervised training of resistance is more beneficial than endurance or enriched environment exercise for adolescents FASD.

Neuropsychological evaluation of children and adolescents with fetal alcohol spectrum disorders in the Brazilian population.

Fetal Alcohol Spectrum Disorder (FASD) is a collective name for lifelong physical and neurodevelopmental problems caused by the gestational consumption of alcohol affecting fetal development. In Brazil, the lack of awareness among healthcare professionals, and the scarcity of suitable diagnostic tools and trained clinicians, can contribute to the underestimation of FASD prevalence and severity. The present review aims to map and analyze studies conducted in Brazil on children and adolescents with FASD or a history of prenatal alcohol exposure (PAE). Additionally, it intends to report the psychometric properties of the neurodevelopmental assessment tools applied in the selected articles. Searches were carried out in the databases Scielo, LILACS, PePSIC, EMBASE, PsycINFO, Web of Science, selecting original clinical studies that have investigated the neurodevelopment of this population. From a total of 175 studies, ten articles fit the inclusion criteria in which 18 instruments were identified. The most reported deficits were related to language, general intelligence quotient (IQ), adaptive behavior, attention, and visual perception. Our results point to the need for more clinical research on FASD in Brazil, as well as for the standardization and validation of neurodevelopmental assessment tools for the accurate diagnosis of FASD in Brazil.

Sexual Dimorphism in the Expression of Cardiac and Hippocampal Renin-Angiotensin and Kallikrein-Kinin Systems in Offspring from Mice Exposed to Alcohol during Gestation.

Prenatal alcohol exposure (PAE) impairs fetal development. Alcohol consumption was shown to modulate the renin-angiotensin system (RAS). This study aimed to analyze the effects of PAE on the expression of the renin-angiotensin system (RAS) and kallikrein-kinin system (KKS) peptide systems in the hippocampus and heart of mice of both sexes. C57Bl/6 mice were exposed to alcohol during pregnancy at a concentration of 10% (v/v). On postnatal day 45 (PN45), mouse hippocampi and left ventricles (LV) were collected and processed for messenger RNA (mRNA) expression of components of the RAS and KKS. In PAE animals, more pronounced expression of AT1 and ACE mRNAs in males and a restored AT2 mRNA expression in females were observed in both tissues. In LV, increased AT2, ACE2, and B2 mRNA expressions were also observed in PAE females. Furthermore, high levels of H2O2 were observed in males from the PAE group in both tissues. Taken together, our results suggest that modulation of the expression of these peptidergic systems in PAE females may make them less susceptible to the effects of alcohol.

Impact of Prenatal Alcohol Exposure on the Development and Myocardium of Adult Mice: Morphometric Changes, Transcriptional Modulation of Genes Related to Cardiac Dysfunction, and Antioxidant Cardioprotection.

The impact of prenatal alcohol exposure (PAE) varies considerably between individuals, leading to morphological and genetic changes. However, minor changes usually go undetected in PAE children. We investigated PAE's effects on gene transcription of genes related to cardiac dysfunction signaling in mouse myocardium and morphological changes. C57Bl/6 mice were subjected to a 10% PAE protocol. In postnatal days 2 and 60 (PN2 and PN60), morphometric measurements in the offspring were performed. Ventricular samples of the heart were collected in PN60 from male offspring for quantification of mRNA expression of 47 genes of nine myocardial signal transduction pathways related to cardiovascular dysfunction. Animals from the PAE group presented low birth weight than the Control group, but the differences were abolished in adult mice. In contrast, the mice's size was similar in PN2; however, PAE mice were oversized at PN60 compared with the Control group. Cardiac and ventricular indexes were increased in PAE mice. PAE modulated the mRNA expression of 43 genes, especially increasing the expressions of genes essential for maladaptive tissue remodeling. PAE animals presented increased antioxidant enzyme activities in the myocardium. In summary, PAE animals presented morphometric changes, transcription of cardiac dysfunction-related genes, and increased antioxidant protection in the myocardium.

Auditory Outcomes in Adolescents with Prenatal Alcohol Exposure.

The aim of the study was to investigate three aspects of auditory function (auditory acuity, cochlear dysfunction, and auditory processing) in adolescents with fetal alcohol exposure without phenotypic changes. Fifty-one adolescents with and without intrauterine exposure to alcohol were selected from a cohort study. The summons, evaluation, and analysis of the results were carried out blindly regarding the respective exposure to alcohol. The auditory tests were pure-tone audiometry, transient otoacoustic emissions, and behavioral assessment of auditory processing (speech-in-noise, dichotic digits, and gap-in-noise). After testing, 45 adolescents were included in the evaluation and were divided into exposed (n = 22) and non-exposed (n = 23) groups. Hearing loss was identified in one subject in the exposed group (4.5%). In the absence of hearing loss, there were no significant differences in tonal thresholds or in the magnitudes of the sensory (cochlear) responses between groups (p > 0.05). There was also no difference between the two groups regarding performance on the processing tests (speech-in-noise p = 0.71, dichotic p = 0.94, and gap-in-noise p = 0.33). However, the exposed group had more cases of hearing disorders (hearing loss plus auditory processing disorders) than the non-exposed group (22.7% vs. 4.3%).

Differential Cortical Pattern in Auditory Task Oddball Paradigm in Children Exposed to Alcohol during Pregnancy.

The negative effects of fetal alcohol exposure on child development are well documented. This study investigated the electrophysiological processing of cortical level acoustic signals in a group of 21 children prenatally exposed to alcohol. Participants aged 13-14 years at the time of the study were recruited from a longitudinal cohort sample. The study employed an observational, cross-sectional blind design and participants were divided into two groups: with and without fetal exposure to alcohol. Neurophysiological measures recorded N1, P2, N2, P3, P3a, and P3b components using the Oddball paradigm. Our results showed that the mothers' sociodemographic conditions at the time of birth, as well as the children's birth weights were homogeneous between the groups, though the Apgar score was lower in the exposed group (EG). The neurophysiological components that showed different results in the groups were P2 and P3a. P2 amplitude was higher in the midline central electrode (Cz) compared to the midline parietal electrode (Pz), demonstrating a group interaction for exposed children. For P3a there was an interaction of group and electrode position, and the EG showed higher amplitudes in Cz compared to the unEG. However, the Apgar score did not influence these results. In conclusion, children who had fetal exposure to alcohol presented electrophysiological recordings distinct from the control group. These differences occurred both in the P2 component - which reflects a bottom-up mechanism of auditory processing - as well as the P3a component, which may reflect the participation of supra-modal hearing mechanisms.

Prenatal Alcohol Exposure in Rats Diminishes Postnatal Cxcl16 Chemokine Ligand Brain Expression.

Maternal ethanol consumption during pregnancy is one of the main causes of Neurodevelopmental disorders (NDD). Prenatal alcohol exposure (PAE) produces several adverse manifestations. Even low or moderate intake has been associated with long-lasting behavioral and cognitive impairment in offspring. In this study we examined the gene expression profile in the rat nucleus accumbens using microarrays, comparing animals exposed prenatally to ethanol and controls. Microarray gene expression showed an overall downward regulatory effect of PAE. Gene cluster analysis reveals that the gene groups most affected are related to transcription regulation, transcription factors and homeobox genes. We focus on the expression of the C-X-C motif chemokine ligand 16 (Cxcl16) which was differentially expressed. There is a significant reduction in the expression of this chemokine throughout the brain under PAE conditions, evidenced here by quantitative polymerase chain reaction qPCR and immunohistochemistry. Chemokines are involved in neuroprotection and implicated in alcohol-induced brain damage and neuroinflammation in the developing central nervous system (CNS), therefore, the significance of the overall decrease in Cxcl16 expression in the brain as a consequence of PAE may reflect a reduced ability in neuroprotection against subsequent conditions, such as excitotoxic damage, inflammatory processes or even hypoxic-ischemic insult.

Prenatal exposure to alcohol impairs social play behavior in adolescent male mice.

Prenatal ethanol exposure affects brain development and causes neural impairment, leading to both cognitive and behavioral consequences in the offspring. Therefore, the aim of this study was to investigate the impact of prenatal exposure to small amounts of alcohol on social play behavior in adolescent male offspring. Swiss mice were prenatally exposed to ethanol by feeding pregnant dams with a liquid diet containing 25% alcohol-derived calories during gestation (alcohol group). They were then compared to both pair-fed dams that received an isocaloric liquid diet containing 0% alcohol-derived calories (pair-fed group) and dams with ad libitum access to a liquid control diet (control group). Additionally, maternal behavior was evaluated in terms of neural activation indexed via c-fos expression in the prefrontal cortex. Although dams exposed to alcohol during pregnancy did not alter their maternal behavior, the offspring presented a decrease in their social play behavior compared with both control and pair-fed offspring. The decrease in social play behavior may be associated with a decrease in number of c-fos-positive cells in the prefrontal cortex. The exposure to small amounts of alcohol during intrauterine development causes both a deficit in social play behavior and a reduction in the neuronal activity seen in the prefrontal cortex.

Phosphatidylethanol Levels in Postpartum Women and Their Newborns in Uruguay and Brazil.

BACKGROUND: There is increasing interest in the development of newborn screening tests to identify children at risk of fetal alcohol spectrum disorder (FASD) in order to provide these children with early intervention. Phosphatidylethanol (PEth) has emerged as a potential universal newborn screening candidate. METHODS: The aim of this report was to present the results of a study designed to compare PEth levels in 1,140 postpartum women and their newborn infants in Montevideo, Uruguay, and Sao Paulo, Brazil. Self-report alcohol use during pregnancy data was collected, along with both maternal and newborn dried blood spot samples for PEth analysis. RESULTS: The average age and parity of the women in the sample were 26 years of age and 2.3 pregnancies. For the Uruguay sample (n = 611), 45.8% of postpartum women had PEth levels ≥ 8 ng/ml with a mean positive PEth of 43.6 ng/ml. In contrast, 86.8% of the newborns had PEth levels ≥ 8 ng/ml, with a mean positive PEth of 77.4 ng/ml. For the Brazil sample (n = 529), 33.2% of women had PEth levels ≥ 8 ng/ml with a mean positive PEth of 31 ng/ml. In contrast, 76.9% of the Brazil newborns had PEth levels ≥ 8 ng/ml and 43.9% with a mean positive PEth of 61.1 ng/ml. PEth levels were significantly higher in newborns compared with their postpartum mothers in both the Uruguay and Brazil samples. Self-reported third-trimester alcohol was 6% in the Uruguay sample and 9.1% in the Brazil sample compared with positive maternal PEth levels in 45.8% and 33.2%, respectively. CONCLUSIONS: Clinicians may want to consider newborn PEth screening in high-risk populations where prenatal alcohol use is common. The mechanism underlying significantly higher PEth levels in newborns compared with their mothers is not known.

Cooking with alcohol: a matched case-control study in Italy and germany assessing the risk of alcoholism due to an early exposure to alcohol in childhood

The study aims at understanding the role of early exposure to ethanol during childhood, in particular in the form of alcohol used in food preparation. A matched case control study was conducted in Italy and Germany. 300 cases were selected from the lists of the Alcoholics Anonymous Associations and 300 controls were matched from the general population. A CATI system was used for collecting information on drinking habits, family risk factors, age at first ethanol consumption, binge drinking episodes and alcohol ingestion as a food ingredient during childhood. Association of variables with the status of case were analysed using a multivariable conditional logistic regression. In the multivariable model four variables were selected: education, father drinking status, age at first ethanol consumption and binge drinking during adolescence. Consumption of food containing alcohol in common recipes was not associated with an increased risk of alcoholism in older ages. Drinkers having their first contact directly with alcoholic beverage before age 13 were more likely to suffer from alcohol dependence at some time during their life. On the contrary, using alcohol in food preparation during childhood does not appear to be related with subsequent risk for alcohol abuse(AU)

El estudio tiene como objetivo comprender el papel de la exposición temprana al etanol durante la infancia, en particular, la forma en la que se utiliza el alcohol en la preparación de alimentos. Este estudio de emparejamiento de casos y controles se llevó a cabo en Italia y Alemania. Se seleccionaron 300 casos de las listas de las Asociaciones de Alcohólicos Anónimos y se los emparejó con 300 controles obtenidos de la población general. Se utilizó el sistema CATI para la recolección de información sobre hábitos de consumo, factores de riesgo de la familia, edad del primer consumo de etanol, episodios de consumo excesivo de alcohol, e ingesta de alcohol como ingrediente alimentario durante la infancia. Se analizó la asociación de las variables con la situación de cada caso mediante una regresión logística condicional multivariable. En el modelo multivariable se seleccionaron cuatro factores: educación, relación del padre con el alcohol, edad del primer consumo de etanol y episodios de consumo excesivo de alcohol durante la adolescencia. El consumo de alimentos que contienen alcohol en las recetas comunes no se asoció con un mayor riesgo de alcoholismo en edades más avanzadas. Aquellos bebedores que han tenido su primer contacto directo con bebidas alcohólicas antes de los 13 años eran más propensos a sufrir de dependencia al alcohol en algún momento de su vida. Por el contrario, el uso de alcohol en la preparación de alimentos durante la infancia no parece estar relacionado con un riesgo posterior de abuso en el consumo de alcohol(AU)

Intelligence and Fetal Alcohol Spectrum Disorders: A Review.

BACKGROUND: Background: The studies on intelligence in individuals with fetal alcohol exposure are conflicting. Some have found a relevant impairment in this population, while others found results that were consistent with the population at large. OBJECTIVES: Describe the results of studies on intelligence in individuals with Fetal Alcohol Spectrum Disorders. METHODS: Indexed articles of the last 10 years were selected for an integrative literature review. After inclusion and exclusion criteria were satisfied 37 articles were selected. RESULTS: General intelligence, both verbal and non-verbal, is impaired in people who are prenatally exposed to alcohol. There is a tendency to a greater reduction in the Freedom from Distractibility/Working Memory Index of Wechsler Scales. CONCLUSIONS: Reduction in intelligence seems to occur on a continuum similar to the fetal alcohol spectrum. The reduction of the Freedom from Distractibility/Working Memory Index appears to be a reflection of a greater impairment of mathematical ability.

Prenatal Alcohol Exposure in Rodents As a Promising Model for the Study of ADHD Molecular Basis.

A physiological parallelism, or even a causal effect relationship, can be deducted from the analysis of the main characteristics of the "Alcohol Related Neurodevelopmental Disorders" (ARND), derived from prenatal alcohol exposure (PAE), and the behavioral performance in the Attention-deficit/hyperactivity disorder (ADHD). These two clinically distinct disease entities, exhibits many common features. They affect neurological shared pathways, and also related neurotransmitter systems. We briefly review here these parallelisms, with their common and uncommon characteristics, and with an emphasis in the subjacent molecular mechanisms of the behavioral manifestations, that lead us to propose that PAE in rats can be considered as a suitable model for the study of ADHD.

A Decision Tree to Identify Children Affected by Prenatal Alcohol Exposure.

OBJECTIVE: To develop and validate a hierarchical decision tree model that combines neurobehavioral and physical measures to identify children affected by prenatal alcohol exposure even when facial dysmorphology is not present. STUDY DESIGN: Data were collected as part of a multisite study across the US. The model was developed after we evaluated more than 1000 neurobehavioral and dysmorphology variables collected from 434 children (8-16 years of age) with prenatal alcohol exposure, with and without fetal alcohol syndrome, and nonexposed control subjects, with and without other clinically-relevant behavioral or cognitive concerns. The model subsequently was validated in an independent sample of 454 children in 2 age ranges (5-7 years or 10-16 years). In all analyses, the discriminatory ability of each model step was tested with logistic regression. Classification accuracies and positive and negative predictive values were calculated. RESULTS: The model consisted of variables from 4 measures (2 parent questionnaires, an IQ score, and a physical examination). Overall accuracy rates for both the development and validation samples met or exceeded our goal of 80% overall accuracy. CONCLUSIONS: The decision tree model distinguished children affected by prenatal alcohol exposure from nonexposed control subjects, including those with other behavioral concerns or conditions. Improving identification of this population will streamline access to clinical services, including multidisciplinary evaluation and treatment.

Inattention and impulsivity associated with prenatal alcohol exposure in a prospective cohort study with 11-years-old Brazilian children.

This paper aimed to examine prenatal alcohol exposure and neuropsychological parameters and its relationship to impulsivity and inattention. Longitudinal prospective case-control cohort study starting with the risk drinking assessment of 449 third-trimester pregnant women, and a follow-up phase with 56 mother-child pairs (28 alcohol-exposed versus 28 non-exposed), with 11-12 years old children. The cohort study was followed up for 11 years. Quantity-frequency structured questions as well as AUDIT and T-ACE questionnaires were used to assess maternal alcohol consumption. A comprehensive set of neuropsychological testing instruments was used, including d2 Test, RCFT, RAVLT, WISC-III, among others. To control low IQ effects and intellectual disability diagnoses, as well differences in school skills biasing the neuropsychological comparison assessment, children with IQ <70 or learning disabilities were excluded of the sample. The two groups showed to be very comparable regarding sex, age, schooling, global IQ, laterality and maternal and social risk factors. Significant statistical differences were found for higher speed processing, total errors, and number of omission errors in the d2 Test. Likewise, there were differences found on RCFT test (lower scores for copy, immediate and delayed recall), and on semantic verbal fluency tests with a lower score. Prenatal alcohol-exposed children seems to be more inattentive and impulsive; they have poorer skills in verbal fluency, visuospatial working memory, and executive processing when compared to non-exposed children who were part of the same cohort sample.

Case study: saturday cognitive habilitation program for children with prenatal alcohol exposure

This case study describes the outcomes of a Saturday community intervention program for children suspected of or affected by prenatal exposure to alcohol who exhibited learning deficits. Five children participated in the program and received individualized interventions designed to address learning and academic deficits in either reading or mathematics. Often children affected by prenatal alcohol exposure exhibit deficits with executive processes, including metacognitive functioning, that interfere with learning. Instruction to improve metacognitive skills was incorporated into the intervention programs. The metacognitive training was adapted from the Math Interactive Learning Experience (MILE) and targeted the children's skills to plan, organize, shift, and evaluate problem solving strategies. Standardized tests of nonverbal reasoning and academic achievement were administered before and after the children received interventions to measure progress. The results indicated that four of the five children who participated in the program showed clinically significant gains with scores increasing from the borderline or low average to the average range on measures of nonverbal reasoning, reading comprehension, or mathematics reasoning. One child showed no gains on measures of nonverbal reasoning and reading. A variety of factors including age, cognitive profile, session attendance, and access to special education and other intervention services may have influenced the child's progress. Overall, the case reviews suggest that the interventions show promise to remediate learning problems of children affected by prenatal alcohol exposure in a community setting.(AU)

Case study: saturday cognitive habilitation program for children with prenatal alcohol exposure

This case study describes the outcomes of a Saturday community intervention program for children suspected of or affected by prenatal exposure to alcohol who exhibited learning deficits. Five children participated in the program and received individualized interventions designed to address learning and academic deficits in either reading or mathematics. Often children affected by prenatal alcohol exposure exhibit deficits with executive processes, including metacognitive functioning, that interfere with learning. Instruction to improve metacognitive skills was incorporated into the intervention programs. The metacognitive training was adapted from the Math Interactive Learning Experience (MILE) and targeted the children's skills to plan, organize, shift, and evaluate problem solving strategies. Standardized tests of nonverbal reasoning and academic achievement were administered before and after the children received interventions to measure progress. The results indicated that four of the five children who participated in the program showed clinically significant gains with scores increasing from the borderline or low average to the average range on measures of nonverbal reasoning, reading comprehension, or mathematics reasoning. One child showed no gains on measures of nonverbal reasoning and reading. A variety of factors including age, cognitive profile, session attendance, and access to special education and other intervention services may have influenced the child's progress. Overall, the case reviews suggest that the interventions show promise to remediate learning problems of children affected by prenatal alcohol exposure in a community setting...

Desempenho intelectual na exposição alcoólica fetal: relato de série de 10 casos / Intellectual performance in fetal alcohol exposure: report of 10 cases series

OBJETIVO: Descrever o desempenho intelectual em uma amostra de crianças e adolescentes que sofreram exposição pré-natal ao álcool. MÉTODOS: Este estudo se constitui em uma série de casos, composta por 10 sujeitos entre 6 e 16 anos, com histórico de exposição alcoólica fetal. Esses sujeitos foram submetidos a uma avaliação médica para serem caracterizados como amostra clínica, respeitando critérios de inclusão e exclusão previamente estabelecidos. O desempenho intelectual da amostra foi estudado por meio dos instrumentos: Escala de Inteligência Wechsler para Criança (WISC-III) e Teste Matrizes Progressivas de Raven. RESULTADOS: A amostra foi caracterizada com desempenho médio inferior pela WISC-III. No Teste Raven, a amostra apresentou desempenho intelectualmente médio. Entre todos os índices da WISC-III, Resistência à Distração apresentou-se mais prejudicado. Os subtestes Aritmética e Arranjo de Figuras apresentaram resultados mais prejudicados comparados ao desempenho obtido nos outros subtestes. O prejuízo dessas funções pode trazer como consequência secundária e dificuldades no aprendizado e na interação social e impactar o desenvolvimento desses jovens. CONCLUSÕES: Os resultados encontrados nesta série de 10 casos foram comparados àqueles descritos em estudos nacionais e internacionais. O prejuízo cognitivo causado pelo uso do álcool na gestação pode se manifestar em crianças em idade escolar por meio da dificuldade de aprendizagem e da dificuldade de estabelecer interações sociais. Dessa forma, a exposição pré-natal ao álcool torna-se um problema de saúde pública, que precisa de maior atenção das políticas públicas nacionais para a realização de identificação e intervenção precoce.

OBJECTIVE: Describe the intellectual performance in a sample of children and adolescents that suffered prenatal exposure of alcohol. METHODS: This report constitutes a case series study, comprising 10 subjects between 6 and 16 years old, with a history of fetal alcohol exposure. These subjects underwent a medical evaluation to be characterized as a clinical sample, respecting the inclusion and exclusion criteria previously established. The sample's intellectual performance was studied by means of instruments: Wechsler Intelligence Scale for Children 3rd. Edition (WISC-III) and Raven's Progressive Matrices Test. RESULTS: The sample was evaluated as being of low medium performance by the WISC-III. In the Raven Test the sample exhibited medium intellectual performance. Among all of the WISC-III indexes, Resistance to Distractions was most impaired. The Arithmetic and Picture Arrangement subtests showed more impairment results in comparison of the others subtests. As a secondary consequence, the impairment of these functions can cause difficulties in learning and social interaction and impact the development of these young people. CONCLUSIONS: The results of these series of ten cases were compared to those reported in national and international studies. The cognitive impairment caused by alcohol use during pregnancy can manifest in school-age children through learning difficulties and difficulty in establishing social interactions. Thus, prenatal exposure to alcohol becomes a public health issue which needs greater attention from national policies to carry out identification and early intervention.

Maternal drinking behavior and Fetal Alcohol Spectrum Disorders in adolescents with criminal behavior in southern Brazil.

Prenatal alcohol exposure can have serious and permanent adverse effects. The developing brain is the most vulnerable organ to the insults of prenatal alcohol exposure. A behavioral phenotype of prenatal alcohol exposure including conduct disorders is also described. This study on a sample of Brazilian adolescents convicted for criminal behavior aimed to evaluate possible clinical features of Fetal Alcohol Syndrome (FAS). These were compared to a control group of school adolescents, as well as tested for other environmental risk factors for antisocial behavior. A sample of 262 institutionalized male adolescents due to criminal behavior and 154 male students aged between 13 and 21 years comprised the study population. Maternal use of alcohol was admitted by 48.8% of the mothers of institutionalized adolescents and by 39.9% of the school students. In this sample of adolescents we could not identify individual cases with a clear diagnosis of FAS, but signs suggestive of FASD were more common in the institutionalized adolescents. Social factors like domestic and family violence were frequent in the risk group, this also being associated to maternal drinking during pregnancy. The inference is that in our sample, criminal behavior is more related to complex interactions between environmental and social issues including prenatal alcohol exposure.